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Though Acevska herself was an immigrant to the United States, her family had ties there going back several generations. Both her great-grandfather and her grandfather moved to the United States ahead of her own parents, in 1917 and 1940 respectively. Her grandfather settled in Mansfield, Ohio, where he opened a restaurant. Acevska was born and raised in the small village of Capari near Yugoslavia's border with Greece.[1] In her youth, she had ambitions to become an astronaut.[2]

Acevska emigrated from Yugoslavia to the United States with her parents and brother in 1966; her father and uncle worked at the restaurant owned by her grandfather.[1] Her maternal relatives remained in Yugoslavia. She had a bicultural Macedonian American upbringing, learning English in school while speaking Macedonian and eating Macedonian cuisine at home.[2] She went on to attend Ohio State University, where she majored in political science.[3] Afterwards, she was a graduate school instructor.[4] She later became a partner and consultant in Middle East-focused international trade and economic development firm Gulf Enterprises.[1][5]

After Macedonia became an independent country in late 1991 with the breakup of Yugoslavia, Acevska, on her visits to the land of her birth, would often urge government officials there to send a representative to Washington. Eventually, President Kiro Gligorov asked her to take on that job, in what was intended to be only a temporary arrangement lasting for two months. She stepped down from her position at Gulf Enterprises in order to focus on the new appointment.[5] At that point, the United States did not yet formally recognize Macedonia, which had several implications for her role.[5] Rather than being accredited as an ambassador and appearing on the State Department's Diplomatic List, she instead registered under the Foreign Agents Registration Act.[5][6] With a budget of only $40,000 per year from the Macedonian government, she took on both diplomatic tasks such as debt negotiations with the International Monetary Fund and dealing with complaints from the State Department about Macedonia's adherence to voluntary export restraints or alleged violations of sanctions against Serbia, and consular tasks such as travel advice to Macedonians holding expired Yugoslav passports.[5]

Acevksa's temporary, short-term role on behalf of the government of Macedonia ended up turning into one of indefinite length.[1] Her efforts on behalf of Macedonia began producing some results around mid-1993, after the U.S. deployed troops in Macedonia; she noted that Washington officials had become "more accessible ... I get my calls returned. I get briefed." However, barriers to formal recognition by Washington remained. State Department officials indicated to Acevska that recognition would not be forthcoming until Skopje resolved its issues in its relationship with Athens, in particular the Macedonia naming dispute and the portions of the Constitution of the Republic of Macedonia which might be seen as staking territorial claims on parts of Greece.[5]

In late 1994, there began to be indications that Washington and Skopje would establish formal relations, and it was reported that Victor Comras, the Foreign Service Officer who had set up the U.S. liaison office in Macedonia, would be the first U.S. ambassador to the country.[1] However, the step of being accredited as an ambassador would require Acevska to relinquish her U.S. citizenship,[5] as it is State Department policy not to grant U.S. citizens diplomatic accreditation as ambassadors of foreign countries.[7] In 1993, Acevska stated to The New York Times that she had not considered the issue up to that point.[5] She later described the experience of giving up U.S. citizenship as strange, but "the right thing to do. And I very much want to help my country — I always felt part of both countries."[2] She was officially appointed as ambassador in November 1995.[4]

Acevska faced various challenges in her role as a young female diplomat in what she described as "an old man's world".[4] When she was accompanied by a male aide, people with whom she met often mistook him to be the ambassador instead, leading her to observe, "I feel sometimes I should wear a sash like Miss America saying, 'I'm the Ambassador.' Ninety percent of the time people [can't grasp it]. Our mentality hasn't caught up with reality."[8] People would call the embassy and, upon hearing a woman's voice, assume they were speaking to a secretary and ask to be connected to the ambassador. Back in Skopje, some resented that she had been able to get such an important role in the Macedonian government, though she stated that most there "were already used to me".[4] Others looked askance at the luxurious accoutrements she had acquired during her former life as an international economic consultant; during her time in office, she "tamed" her wardrobe somewhat.[5][9]

Acevska served as ambassador until 2002, when she was succeeded by Nikola Dimitrov; he was the youngest ambassador in Washington at that point, even younger than Acevska had been when she first took up her unofficial liaison role for Macedonia.[10] Acevska went on to become a public policy scholar at the Wilson Center, and later became involved with humanitarian work in Haiti.[11][12]

Acevska received the Alumni Medalist Award from her alma mater Ohio State University in 1996 for "international distinction in service to humanity".[4] In 2000, she was named Ambassador of the Year by the Women's Ambassador Program for her work with Howard University international relations students.[13]